The Institute on Human Values in Medicine: its role and influence in the conception and evolution of bioethics.

For ten years, 1971-1981, the Institute on Human Values in Medicine (IHVM) played a key role in the development of Bioethics as a field. We have written this history and analysis to bring to new generations of Bioethicists information about the development of their field within both the humanities disciplines and the health professions. The pioneers in medical humanities and ethics came together with medical professionals in the decade of the 1960s. By the 1980s Bioethics was a fully recognized discipline. We show the role that IHVM programs played in defining the field, training faculty and helping schools to develop programs. We review, the beginnings of the IHVM in the crucible of social and technological change that led to the establishment of the IHVM's parent organization, the Society for Health and Human Values. We then turn to the IHVM programs through which Faculty members received fellowships to explore new crossovers between the humanities and the health professions. We have not only described the Fellows Program as it existed in 1973-1980, but have completed a survey of the fellows a quarter of a century after they held their fellowships. We describe other IHVM programs designed to facilitate the initiation and development of new humanities programs, to explore conceptual issues between medicine and five humanities fields, to conduct issue driven or educational method conferences and to advance humanities programs into graduate education through the Directors of Medical Education.

Medical ethics in medical education: finding and keeping a place at the table.

Although almost three decades have passed from the early days of the modern medical ethics movement, both articles discussed here manifest variations of some old concerns. First, an acceptance of ethics is incorporated into general requirements and found in specific programs, but ethics is not given great attention by those who decide who will enter the medical profession. Second, in the clinical setting itself, practitioners are busy and the teaching process is placed amidst a multitude of other concerns. And third, the goals for resident and faculty education are remarkably similar to those proposed for undergraduates (awareness, development of analytical skills, involvement in patient care, and so forth). The evaluation of ethics instruction, which has been a concern since the 1960s, has a new face. Upon entering the medical-education setting, humanists found that there was a need for accountability that they had not generally experienced in their university teaching. Yet, they also knew that ethics was different from other medical courses, and that quantifying its special contribution was difficult. Today's general societal emphasis on cost and outcome as measures of the value of education gives consideration of evaluation a critical role. White and Zaner, and most of the other authors cited here, mention the need for systematic accounting of the results of teaching, as well as the difficulty of evaluation. The evaluation of the effectiveness of ethics instruction will remain problematic, yet it is necessary in the changing health-care market. To the degree to which it is possible to communicate knowledge about ethics, residency and other accrediting bodies can provide means to evaluate the results of teaching.(ABSTRACT TRUNCATED AT 250 WORDS)

Ethical concerns about AIDS.

The HIV/ARC/AIDS story continues to unfold. It is both the old, sadly familiar experience of plague and disease, of lepers isolated as unclean, of smallpox decimating the American Indians, of a Black Death sweeping medieval Europe, of the 1918 influenza. It is also a new story, one in which medical scientists rather quickly identified the causative infectious agent but, as yet, have been unable to cure the infection, although some amelioration of the basic course of the illness appear possible if treatment with AZT is begun relatively early. The ethical problems are numerous and constantly change as the understanding of the disease and its potency evolves. The social answers have, after initial delay, received positive action on an official level. On the more personal level of the average American there remains animosity, prejudice, and a deeply rooted fear, the ancient fear of the leper, of the plague victim. The health professionals have also officially responded well to the challenge of AIDS. Personally, as in society generally, there has been a mixed response. We believe that the ethical concerns enumerated in this article will be resolved in favor of persons with AIDS. Nevertheless, the personal, spiritual, emotional, and economic isolation experienced by persons with AIDS and their families challenge us about what kind of society we wish to be. We will ultimately be measured as a civilization by the way in which we treated the least fortunate. America's track record in this regard has been mixed. AIDS presents us with a chance to change.

Placing the humanities perspective in the health professional curriculum.

Most health professional education consists of three separate stages: a general background that provides a humanities perspective, a core of basic science or theory courses, and lengthy clinical experiences. Challenges to this strict compartmentalization and sequencing have led to limited humanities and social sciences training for health professional students. A constant struggle for time allocation occurs between preclinical and clinical faculty. What place can be found in an already crowded curriculum for a humanities perspective, especially when this perspective has supposedly been addressed at an earlier stage in each student's education? This article proposes that a humanities perspective is one of three distinct themes of a professional's education (along with theory and practice) and also the necessary cultural context out of which the professional judges him- or herself. The importance of the humanities perspective is such that the present sequenced pattern should be reconsidered and more attention given to the integration of the three major educational themes throughout students' training.